Treatment of obesity in children and adolescents

The treatment of obesity in children and adolescents is based on lifestyle changes. Nutrition, physical activity and screen time are the three biggest factors that influence a child’s weight development. Making the whole family more active in everyday life is the best way to support children’s health and weight development.

Family-based weight management programmes for overweight children and adolescents have been shown to be effective in improving eating and exercise habits and reducing excessive sedentary behaviour, including screen time. It is worth noting the eating and other daily habits that already support health in the family. Harmful habits are often reduced. For children and young people, it is important that the child’s or young person’s family is committed to their care.

Drug treatment for obesity may be considered as an adjunct to lifestyle treatment for young people over 12 years of age, but it is not a substitute for guidance on lifestyle changes. Obesity surgery may be considered for young people aged 13–18 years if conservative treatment of obesity is not effective and the young person’s obesity significantly reduces quality of life or causes comorbidities.

A regular meal rhythm and proper meals are essential for the growth and development of children and adolescents

Daily meals should include breakfast, lunch, dinner, any healthy snacks and an evening meal. E.g. My Plate is the US Department of Agriculture’s (USDA) set of recommendations for healthy eating. They include following goals: low in added sugar and in concentrated fat, nutrient dense but not calorie dense, within an appropriate calorie range as well as with balanced protein and carbohydrate. A good diet is easy to formulate using a plate model and a food pyramid.

Key points of nutritional counselling for child obesity:

• Parents do not use food as a reward, nor as a consolation.
• Children and parents eating together at the dinner table
• Support full breastfeeding for the first six months
• Regular meal rhythm (five meals/day)
• Vegetables, berries and fruit served at every meal
• During meals, external stimuli such as TV and phones are turned off
• Drinking water
• Soft drinks are avoided
• Eating sweets in moderation
• Fast foods are eaten only occasionally
• Children and young people are encouraged to participate in school meals

60 minutes daily of physical activity

Regular physical activity makes people feel good and gives a sense of well-being and well-being in everyday life. It also promotes health and improves fitness. For all 7–17 year olds, it is recommended to exercise at least one hour a day at an age-appropriate level, with varying levels of physical activity. Prolonged periods of sedentary behaviour should be avoided. Children should be offered a range of physical activity options.  Children should be encouraged to engage in everyday activities such as walking, cycling, stair climbing and playing.

Key points of physical activity counselling:

• Before school age, children need three hours of vigorous physical activity a day, including play, playful activities and a variety of physical activities.
• School-age children need at least one hour of varied and age-appropriate physical activity every day
• Children are offered a range of physical activity options from which they can choose the one they prefer.
• Moving together with children
• Children are encouraged to take part in everyday activities such as walking, cycling, stair climbing and playing

Appropriate, not-excessive media use

Obesity is one of the first health effects of excessive screen time to have been studied. Even more than two hours of screen time per day contributes to obesity. Excessive screen time may also influence the eating behaviour of adolescents. Reduced screen time has shown improvement in BMI measures, although with small impact.

No screen time at all is recommended for children under 2 years of age; for 2 –5-year-olds, only one hour of screen time per day. For children and young people aged 5–17, the maximum amount of screen time should be two hours per day. Time spent on schoolwork is not counted as screen time.

Guidance focuses on creating a balanced and safe daily life and healthy lifestyle

Management of overweight and obesity in children and adolescents focuses on creating a balanced and safe daily life and healthy lifestyle. It includes diet, physical activity, rest and restorative activities, adequate sleep and social relationships for both children and parents.

During lifestyle counselling, the family discusses general nutrition and physical activity recommendations and identifies support from friends and family. They will learn how to identify potential emotional eating and high-risk situations. For young people, it is important to find out their body image and to build their self-confidence by encouraging them. They should be encouraged to maintain healthy habits. Young people should be instructed to set goals for themselves and reward themselves for them.

For children and adolescents, weight management generally focuses on dietary changes, increasing physical activity and preventing weight gain. Family-oriented and weight-neutral approaches are particularly emphasized. The aim is to have regular appointments with the nurse over several months. Guidance includes, for example, the use of different guidance materials to support the guidance, such as a plate template and a food pyramid, as well as guidance on nutrition and physical activity recommendations.

Parents and teachers act as role models and encourage children to adopt healthy lifestyles, preventing overweight and obesity.

The weight indicator can be used to illustrate overweight and provide neutral information about the risks of overweight and obesity. During the visit regular weight monitoring will be done. Identifying and guiding the causes of overweight without blaming the parents or the child, giving concrete advice and applying it to the family’s daily life, encouraging weight management and providing developmental and motivational feedback are a good basis for weight management.

Children’s other growing environments, such as school, have a significant impact on children’s and young people’s eating habits and physical activity. One aspect of food and physical activity education in schools and at home is the involvement of school staff and families. Parents and teachers act as role models and encourage children to adopt healthy lifestyles, preventing overweight and obesity.

The power of multi-professional co-operation

The importance of multi-professional and multi-disciplinary evidence-based weight management guidance is highlighted in the context of weight management for children and adolescents. Often, concerns about a child’s or young person’s weight management start at home and may be raised by a teacher or at a health check-up by a nurse. The nurse may consult specialists such as a nutritionist or physiotherapist. If necessary, the child or adolescent can be referred to a pediatrician. Sometimes a psychologist can be contacted if necessary.

A treatment plan drawn up jointly by a multidisciplinary team can be used to help a child or young person manage their weight. Together, the multidisciplinary team will make a care plan in collaboration with the family.

 

 

Authors

Alexandra Kaljunen, Public health nurse student, RN, Turku UAS

Meri Lanamo, Public health nurse, Turku UAS

Jessica Rantanen, Public health nurse, Turku UAS

Maika Kummel, PhD, Principal lecturer, Public health nurse, Turku UAS